Longitudinal Analysis Between Maternal Feeding Practices and Body Mass Index (BMI): A Study in Asian Singaporean Preschoolers

Phaik Ling Quah, Jing Chun Ng, Lisa R Fries, Mei Jun Chan, Izzuddin M Aris, Yung Seng Lee, Fabian Yap, Keith M Godfrey, Yap-Seng Chong, Lynette P Shek, Kok Hian Tan, Ciaran G Forde, Mary F F Chong, Phaik Ling Quah, Jing Chun Ng, Lisa R Fries, Mei Jun Chan, Izzuddin M Aris, Yung Seng Lee, Fabian Yap, Keith M Godfrey, Yap-Seng Chong, Lynette P Shek, Kok Hian Tan, Ciaran G Forde, Mary F F Chong

Abstract

Bidirectional studies between maternal feeding practices with subsequent child weight are limited, with no studies in Asian populations. In longitudinal analyses, we assessed the directionality of the associations between maternal feeding practices and body mass index (BMI) in preschoolers. Participants were 428 mother child dyads from the GUSTO (Growing Up in Singapore Toward healthy Outcomes) cohort. Feeding practices were assessed using the Comprehensive Feeding Practices Questionnaire (CFPQ) at age 5 y. Child BMI was measured at ages 4 and 6 y. BMI and maternal feeding practices subscales were transformed to SD scores and both directions of their associations examined with multivariable linear regression and pathway modeling. Higher BMI at age 4 was associated with lower encouragement of balance and variety (β = -0.33; 95%CI: -0.53, -0.13), lower pressure to eat (β = -0.49; -0.68, -0.29) and higher restriction (β = 1.10; 0.67, 1.52) at age 5, adjusting for confounders and baseline feeding practices at 3 years. In the reverse direction, only pressure and restriction at age 5 were associated with lower and higher child BMI at age 6 years, respectively. After the adjustment for baseline BMI at age 5, the association with pressure was attenuated to non-significance (β = 0.01 (-0.01, 0.03), while the association with restriction remained significant (β = 0.02; 0.002, 0.03). Overall, associations from child BMI to maternal restriction for weight control and pressure feeding practices was stronger than the association from these maternal feeding practices to child BMI (Wald's statistics = 24.3 and 19.5, respectively; p < 0.001). The strength and directionality suggests that the mothers in the Asian population were likely to adopt these feeding practices in response to their child's BMI, rather than the converse. Clinical Trial Registry Number and Website This study was registered at clinicaltrials.gov as NCT01174875 (www.clinicaltrials.gov, NCT01174875).

Keywords: Asian cohort; Child BMI z-score; GUSTO; bidirectional associations; comprehensive feeding practices questionnaire (CFPQ); maternal feeding practices; preschoolers.

Figures

Figure 1
Figure 1
Flow chart of study participants included at timepoints 4, 5, and 6 years old.
Figure 2
Figure 2
Path models including associations between maternal feeding practices and child BMI in both directions (n = 428). Values represent β's derived from linear regression analyses as presented in Table 4 after the adjustment for potential confounders and baseline outcomes. Paths were adjusted for confounders (for age of CFPQ assessment, early BMI during early pregnancy (15 weeks), child birth order, and duration of breastfeeding, maternal ethnicity, and maternal education), and maternal feeding practices at child age 3 y (only in child-BMI at 4y to maternal feeding practices at 5y regressions) and child BMI at age 4 y (only in maternal feeding practices to child-BMI regressions). *p < 0.05 was statistically significant.

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